A seven-month-old male Standardbred was referred with a 4-month history of left jugular groove distension. On physical examination severely dilated left maxillary, linguofacial and jugular veins were appreciable. Blood gas analysis results indicated higher degree of oxygenation in the left jugular vein. Bi-directional flow signals, with normal systolic and early diastolic flow, and late diastolic retrograde flow, were noted on pulsed-wave Doppler interrogation and color flow mapping of the left jugular blood flow. A systolic-diastolic signal with spectral broadening was detected when positioning the sample gate near the internal jugular wall, in the distal left cervical region. Color Doppler imaging of the same region showed blood flow passage between the left common carotid artery and the left jugular vein through a small carotid-jugular fistula. Markedly increased blood flow velocities and volumetric flow, and decreased resistive index were recorded in the left compared to the right common carotid artery.